Wieners and other cry babies and their diagnostic
tests
Well this
time I am writing about my favorite subject- criticizing anyone- but this time
medical practice in TN (including fancy nonsense like sidha, homeopathy and all
the pathies including Physiotherapy).
I am
writing this after a TV program in TN (which fortunately I did not watch) which
created a controversy and wieners in the medical profession are crying about it
(including PTs ).
The first
relates to overuse of diagnosis in practice and getting substantial illegal
money for it. This again is also prevalent in PT and other pathies. I am not
going into the issues highlighted in the program as we all know it is an open
secret -that for every medical test the medical practioner gets at least 50 %
as illegal black money (it should not be called commission- as it might be a
legal tender for example what a real estate agent gets).
The first issue in requesting a diagnostic test is that it should increase your
probability of the possible disease. Also we should have an assumption (a
pre-test probability) that this person may be suffering from this particular
disease and then do the test. You should not do it wily nily on all the
patients. For example you do a test for malaria on patients with symptoms like
paroxysmal symptoms of fever shivering body pain etc. You don’t do it on all
the patients who come to the GP with fever. Or you don’t do preg-test for all
the women who enter the OBG clinic.
However,
this is what happens in case of LBP- either a MRI or a X-ray is ordered by
–well any idiot with a pen and thinks he/ she is a doctor (which again includes
PTs and other nonsensical profession like sidha etc). Why pray is a problem? - The
biggest problem is we are going to have over diagnosis and lots of false
positive. Second is the harm the patient is exposed to- the X-ray is not a
torch light. Third is harm of teaching an anatomical or a pathological model of
pain which is the biggest harm i presume, as it might impede the prognosis of
the patient.
The second issue is a test (like an x-ray or MRI) should change your treatment
after the patient undergoes it. For example, if you have a patient with LBP and
you are thinking of exercise and some passive treatment like IFT or manual
therapy after the patient has got an x-ray or MRI the treatment should change. I
am pretty sure after X-ray none of PT management is going to change (if there
is no red flag). A second example can be an x-ray for OA knee patient- will the
treatment change because the patient has a joint space narrowing or osteophyte-
the answer is no for any treatment. However, when a patient with OA is not
getting better, his joint movements are very restrictive and when you are contemplating surgery then
you need a x-ray as it may influence your change in management- that is joint replacement.
Hence, most
of the time if you are ordering for an x-ray – you should be thinking – does
this patient has a red flag. That is we should be having a big concern or
suspicion that the patient is having a systemic disease and that is causing the
pain. Next if you are ordering for a MRI- probably the patient is being posted
for surgery- as you can imagine surgery is different treatment than
conservative management.
So cry
babies in medicine should first learn medical theories and best practice
methods and then cry wolf. The next post we will see why screening is good for
only doctors and hospitals and not for patients.
So for
medical professionals the lessons are if most of your patients with pain are
getting an X-ray- you are over utilizing diagnostic tools. If you most of your
patient are getting a MRI (for pain) the you are not only a moron you are also
a cheat and a criminal (as you are also getting illegal money from the center)
For patients-
1. Ask your
doctor why and how will the “test” will help me in getting better
2. Even for
a simple blood test ask the 101 question you ask you cable operator when he
comes to collect the paltry sum of 100rs
3. Tell
your doctor to f!@# off he tells you to get the test in his favorite lab-well
go and complain in a consumer forum or just write nasty things about the system
on the net- see what happened when a uneducated said nasty things about doctors
4. Remember medicine is also a business not a
noble profession (that was 30 years back) so shout at them when the service is
poor or you are not satisfied- as in case of with your mobile phone operator
Reference:
Homer simpson: “What's the point of going out? We're just gonna wind up back here anyway.”
